Inguinal hernia repair (keyhole)

An inguinal hernia — a bulge in your groin where bowel or fatty tissue has pushed through a weak spot in the abdominal wall — won't get better on its own, and it won't go away without treatment. But here's the reassuring part: fixing it is one of the most common operations performed in Australia.

Two closely related keyhole techniques are used. The first is robotic TAPP (transabdominal preperitoneal — a mouthful, but it simply means small instruments pass through tiny cuts in the abdomen to reach the hernia from behind). The second is eTEP (extended totally extraperitoneal — meaning the entire repair is done in the space behind the abdominal lining, so the inside of the abdomen is never entered at all). Both approaches use just three tiny cuts — each about one centimetre — and place a large, flat mesh patch behind the weak area to reinforce it properly.

Because the mesh sits behind the muscle rather than in front of it, the repair is not under any tension. In published series, these keyhole techniques are associated with less post-operative pain, faster recovery, and a lower chance of the hernia coming back than traditional open surgery.

• Your groin hernia is causing pain, an aching dragging feeling, or is simply stopping you from doing the things you normally do — whether that's lifting, working, or exercising
• Your hernia is stuck (this is called irreducible — meaning it won't push back in when you lie down), or it has come back after a previous repair
• You have hernias on both sides of your groin — both can be fixed in a single operation through the same three tiny cuts, so you only go through surgery once
• You're working-age or physically active and getting back to normal life quickly matters to you
• Your hernia has returned after a previous open repair — the keyhole approach comes in from a completely different direction (from behind), so it avoids the scar tissue left from the first operation
• You have a femoral hernia (a closely related type of groin hernia that sits slightly lower and deeper) — this can be found and repaired at the same time, through the same cuts

• In published series, keyhole repair is associated with less post-operative pain than open surgery — most people manage comfortably with regular paracetamol rather than strong prescription pain relief
• Only three tiny cuts (each roughly the size of your fingernail), which means less risk of wound complications and barely any visible scarring
• If you have hernias on both sides, both are fixed through the same three cuts — no extra incisions and no second operation
• The large mesh patch covers the entire weak area generously; published recurrence rates with keyhole repair are lower than those reported for open repair
• Most people are back at a desk job within a week or two and feel themselves again well within a month
• Because the keyhole approach works from behind, it avoids cutting across the sensory nerves in your groin; published rates of long-term groin discomfort are lower than after open repair

• Seroma — this is a pocket of fluid that collects in the space where the hernia sac used to sit. It happens in about 5–10 in every 100 cases, and it can look or feel like the hernia has come back. It almost always disappears on its own over a few weeks without any treatment at all, but it can be alarming if you don't know to expect it. If you notice swelling after the operation, please call us before worrying — it's very likely just this
• Mesh infection — uncommon; fewer than 1 in 100 patients experience this
• The hernia returning — about 1–3 in every 100 people at five years; published recurrence rates are lower than with open surgery
• Ongoing groin discomfort — affects roughly 1–3 people in every 100; again, lower than the published rates after open repair
• Injury to the vas deferens (the slender tube that carries sperm) or to the blood vessels supplying the testicle — this is rare. The likelihood in your specific case will be discussed with you before your operation
• General anaesthetic risks — your anaesthetist will walk you through these at your pre-operative assessment; for most healthy people, the risks are small

If you take blood thinners, diabetes medication, GLP-1 weight-loss injectables, or iron supplements, please flag this when you book — these need specific adjustments before the procedure. Full details are in the guide above.

• If your weight is on the higher side, even a modest reduction beforehand can meaningfully lower your surgical risk — this will be raised with you at consultation if it applies, without judgment
• This operation is done under a full general anaesthetic, meaning you will be completely asleep and will not feel or be aware of anything. You will need a trusted person to drive you home and stay with you for the rest of that day
• No bowel preparation is needed — there is no need to take laxatives or do anything special to your bowels
• Before your operation, everything is explained in detail — what the mesh is, why it is used, the small chance of the hernia coming back, and what to do if a swelling (seroma) is noticed afterwards. This is your time to ask anything at all, and the consent form is signed only once you feel properly informed

• You will be admitted to the day-surgery unit at Warringal Private Hospital or Epworth Eastern on the morning of your operation. Once you are comfortably asleep under the general anaesthetic, three small incisions are made in the abdomen — each roughly one centimetre — to insert the keyhole instruments
• In a TAPP repair, a small opening is made in the peritoneum (the thin membrane lining the inside of your abdomen) to reach the hernia from behind. In an eTEP repair, the entire operation is carried out in the space between the abdominal muscle and that lining — so the inside of your abdomen is never entered at all
• The hernia is carefully identified and the tissue that has pushed through is gently guided back to where it belongs
• A large, lightweight mesh patch is positioned to cover the entire weak area — this is the foundation of the repair and what prevents the hernia from returning
• If a TAPP approach was used, the peritoneal lining is closed back over the mesh. All three small cuts are then neatly closed
• You'll wake up comfortably in the recovery room. After a few hours in the day-stay unit while the anaesthetic fully wears off, most people are ready to go home on the same day

• Day of surgery and the day after: Rest at home. You will notice some groin soreness, and possibly some bloating or shoulder discomfort from the gas used during the keyhole procedure — this is normal and passes within a day or two. Regular paracetamol taken as directed on the packet handles this well for most people. Take it easy and let someone look after you
• Days 2–3: You should be moving around the house comfortably and able to look after yourself. Short, gentle walks are actively encouraged — the body heals better when it is gently moving
• After 1 week: Most people feel ready to return to a desk-based or office job. You can drive again once you are confident you could do an emergency stop without hesitation — usually within a few days to a week. If in doubt, wait a little longer
• For the first 1–2 weeks, avoid heavy lifting, pushing, or pulling — a useful guide is nothing heavier than about 5–10 kg (the weight of a small grocery bag), unless told otherwise. Light household tasks, sitting, and walking are fine as long as they do not cause pulling at the groin. After 1–2 weeks, heavier lifting can gradually resume as comfort allows
• After 4–6 weeks: Most people are back to manual work, the gym, sport, and all the activities they enjoy. This is the milestone most active people are working towards
• Sexual activity is fine again after about 2–3 weeks, whenever you feel comfortable
• A post-operative review is routinely arranged 2–6 weeks after your operation — this review is provided at no charge, and it is your chance to ask any questions that have come up during recovery
• For day-by-day guidance on wound care, activity progression, what a seroma feels like, and when to return to driving, lifting, and sport, see the Post-hernia-repair aftercare guide on the Resources page.

Post-operative concerns: Please call our rooms on (03) 9816 3951 and leave a message — this will be sent directly as a text to Mr Nguyen. Alternatively, you may text the office mobile on 0499 090 126. We aim to respond promptly during business hours.

Emergencies: For any life-threatening emergency, call 000 immediately or go to your nearest emergency department. Do not wait for a call back from our rooms. For the Austin Hospital Emergency Department: (03) 9496 5000.